褥瘡から発生した脊髄損傷患者の化膿性股関節炎に対する股関節切除術

Resection Arthroplasty for Septic Arthritis of the Hip Complicating Pressure Ulcers in Spinal Cord Injury Patients

　背景：脊髄損傷患者では褥瘡から化膿性股関節炎を発症することがあり，治療に難渋することがある．これらの症例の手術成績を調査した．

　対象と方法：褥瘡から発症した脊髄損傷患者の化膿性股関節炎に対して股関節切除術を施行した16例19股を対象とした．

　結果：19股のうち13股(68%)は初回手術で治癒した．残りの6股は再手術を要した．大腿骨頚部での股関節切除例よりも大腿骨転子下での切除例のほうが初回手術での治癒率が高かった．

　まとめ：転子下での股関節切除が望ましいが，術後の座位バランス・車椅子移乗動作への影響を考慮する必要がある．

　Background：We investigated the surgical outcomes of resection arthroplasty for septic arthritis of the hip as a complication of pressure ulcers in spinal cord injury patients.

　Methods：There were 16 subjects (19 hips).　All patients were non-ambulatory.　Greater trochanteric pressure ulcers were the main source of the septic arthritis of the hip.　Treatment consisted of resection at the subtrochanteric level in 15 hips and resection at the femoral neck in 4 hips.

　Results：A cure was achieved by the initial operation in 13 hips, but the other 6 hips required reoperation.　Resection arthroplasty at the subtrochanteric level yielded better results than resection arthroplasty at the femoral neck.

　Conclusions：Resection arthroplasty at the subtrochanteric level is recommended, as the surgical treatment for septic arthritis of the hip complicating pressure ulcers in spinal cord injury patients, but care must be exercised in regard to the probable postoperative changes in ADL.